The use of probiotics, prebiotics and synbiotics in the management of irritable bowel syndrome

Although preparations incorporating prebiotics, probiotics or even both have been used for some time by individuals with irritable bowel syndrome (IBS), it is only recently that these approaches to the management of this common and challenging disorder have attracted the attention of medical scientists and clinicians. This interest is, in large part, related to the explosion in understanding of the gut microbiota in health and disease - recent data have, indeed, implicated the microbiota in IBS. While clinical scientists develop a rationale for the use probiotics and prebiotics in IBS, others have been subjecting these products to the rigors of high-quality clinical trials. Although several lines of evidence now provide a plausible basis for the use of interventions that seek to modify the microbiota in IBS, the number of appropriately powered, optimally designed clinical trials still remains small. Probiotic trials in IBS are difficult to compare because of differences in dose, strain and formulation - however, available evidence does suggest that benefits do come from the use of probiotics. In some instances, the effects are limited to some individual IBS symptoms, whereas in others, there seems to be a more global impact. Data to support the use of prebiotics are more limited at this stage. The microbiota-host interface has proven to be a fertile ground for research in IBS and offers therapeutic potential for this common disorder.